原发性醛固酮增多症患者的血脂代谢特点及左心室质量指数的独立危险因素

Characteristics of Lipid Metabolism and Independent Risk Factors for Left Ventricular Mass Index in Patients with Primary Aldosteronism

目的 探讨原发性醛固酮增多症(PA)患者的血脂代谢及其心脏靶器官损害的特点,及影响PA患者左心室质量指数(LVMI)的独立危险因素。方法 收集2015年5月至2018年12月西安交通大学第一附属医院收治的PA患者(84例)和同期住院性别、年龄、高血压病程、高血压水平相匹配的原发性高血压(EH)患者(102例)的临床基本资料、常规生化指标、血脂水平[包括甘油三酯、胆固醇、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白(A、B、E)和脂蛋白a水平]及超声心动图主要指标[包括左心室舒张末期直径(LVDd)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、射血分数(EF)、左心室质量(LVM)及经体表面积(BSA)较正的左心室质量指数(LVMI)],分析2组患者生化指标、血脂水平及心脏损害的特点,进一步分析PA患者LVMI的独立危险因素。结果 PA组甘油三酯、LDL-C和载脂蛋白B水平均低于EH组(均P<0.01),而HDL-C、载脂蛋白A和脂蛋白a水平均高于EH组(P<0.05或P<0.01)。相关性分析显示,PA组LVMI与高血压病程、收缩压、舒张压呈正相关,与估算肾小球滤过率(eGFR)呈负相关(P<0.05或P<0.01或P<0.001)。多元逐步回归分析显示,收缩压及eGFR是PA患者LVMI的独立危险因素。结论 PA患者血脂代谢异常程度较EH患者轻,但心脏损害更为严重。收缩压、eGFR可能是PA患者左心室肥厚的独立危险因素。

Objective To explore the characteristics of lipid metabolism and cardiac damage and the independent risk factors affecting left ventricular mass index(LVMI) in patients with primary aldosteronism(PA).Methods Clinical data of 84 PA patients and 102 essential hypertension(EH) patients matched for gender,age and hypertension duration and level who were admitted to the First Affiliated Hospital of Xi’an Jiaotong University from May 2015 to December 2018 were collected in this study.The routine biochemical indexes,blood lipid levels(triglyceride,cholesterol,low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),apolipoprotein(A,B,E) and lipoprotein A),and echocardiographic indicators(left ventricular end-diastolic diameter,interventricular septum thickness,left ventricular posterior wall thickness,ejection fraction,left ventricular mass,and left ventricular mass index(LVMI) adjusted with body surface area) were compared between the two groups.The characteristics of biochemical indexes,blood lipid levels and cardiac damage were analyzed in both groups.Furthermore,the independent risk factors for LVMI were analyzed in PA patients.Results The levels of triglycerides,LDL-C and apolipoprotein B in PA group were lower than those in EH group(P<0.01),while the levels of HDL-C,apolipoprotein A and lipoprotein a in PA group were higher than those in EH group(P<0.05 or P<0.01).Correlation analysis showed that the LVMI was positively correlated with the duration of hypertension,systolic blood pressure and diastolic blood pressure,but negatively related to the estimated glomerular filtration rate(eGFR) in PA group(P<0.05,P<0.01 or P<0.001).Multiple stepwise regression analysis indicated that systolic blood pressure and eGFR were independent risk factors for LVMI in PA patients.Conclusion PA patients have less severe lipid metabolism abnormalities but more serious cardiac damage than EH patients.The systolic blood pressure and eGFR may be independent risk factors for left ventricular hypertrophy in patients with PA.